Objective:To analyze the temporal and spatial trends of maternal mortality in China, and to predict the future situation of maternal mortality.Methods:Taking the national maternal mortality rate in 1991-2018 and the maternal mortality rate in 2009-2018 in various provinces and cities of China as the research objects, using the statistical description analysis method to analyze the changes of time and space of maternal mortality, and using ARIMA time series model to predict the future situation of maternal mortality in China, rural areas and cities.Results:Regarding to the spatial and temporal distribution of maternal mortality, the maternal mortality rate in China generally showed a certain decline trend. In 1991, the maternal mortality rate was 80.0/100 000, and in 2018, China′s maternal mortality rate was 18.3/100 000, 77.1% lower than that in 1991, with an average annual growth rate of-5.3%; In 2009, Tibet′s maternal mortality rate was the highest, 232.2/100 000, and Jiangsu′s maternal mortality rate was the lowest, 5.2/100 000, with a difference of 44.7times After nine years of development, Tibet is still the province with the highest maternal mortality rate in China, which is 56.5/100 000, while Shanghai has the lowest maternal mortality rate, which is 1.4/100 000, with a difference of 40.4times. In 1991, the rural and urban maternal mortality rates were 46.3/100, 000 and 100.0/100, 000, respectively, and the urban-rural mortality rate was 1∶2.16. By 2022, the urban-rural mortality rate in China was 1∶0.95. Regarding the prediction of maternal mortality for the future, the national maternal mortality rate in 2022 is 10.1/100 000, the urban maternal mortality rate is 16.0/100 000, and the rural maternal mortality rate is 15.0/100 000.Conclusion:The maternal mortality rate in China has been greatly reduced, and the gap between urban and rural areas has decreased from 53.7/100 000 in 1991 to 0.7/100 000 in 2022, showing a downward trend. However, from the model prediction results, there is a slight rebound in the urban maternal mortality rate, while the rural maternal mortality rate remains stable, which suggests that the government and the health administration should pay more attention to the growing trend of urban maternal mortality while taking reasonable measures to reduce the rural maternal mortality rate, so as to avoid the rebound of urban maternal mortality rate.

Objective To establish in vivo and in vitro the characteristic chromatograms of Mongolian medicine compound formula-Shudage-4,and affiliate and identify in vitro chemical compositions of Shudage-4 and its compositions in vivo absorbed into blood.Methods Wistar rats were intragastrically given Shudage-4 and its different single medicinal,and then serum samples were prepared and determined by using high performance liquid chromatography (HPLC).The HPLC characteristic chromatograms of in vitro samples of Shudage-4 and its different single medicinal and Shudage-4 medicated serum were established and analyzed.The chemical compositions in vitro of Shudage-4 and its compositions in vivo absorbed into blood after taken by rats were compared,affiliated and identified.Results There were totally 64 peaks found after analyzing in vitro HPLC characteristic chromatograms of Shudage-4.There were 23 chemical compositions absorbed into blood,and 17 in vitro ones absorbed directly into blood and 6 speculated as new metabolites.These 23 chemical compositions were all derived from different were derived from Gaoliangjiang (Rhizoma Alpiniae Officinarum,Galangal Rhizome),peak 14,from Muxiang (Radix Aucklandiae,Common Aucklandia Root) and peak 13,from Shichangpu (Rhizoma Acori Tatarinowii,Grassleaf Sweetflag Rhizome).The peaks 15,20,21 and 22 were derived from Gaoliangjiang,Muxiang and Shichangpu,peaks 6,10,17,18 and 19,from Gaoliangjiang and Shichangpu,peaks 7 and 16,from Gaoliangjiang and Muxiang,peak 11,from Muxiang and Shichangpu,and peaks 4,5,8 and 12,from the whole formula of Shudage-4,from which 7 chemical compositions were identified.Conclusion The chemical compositions and metabolites in blood may be the active principles of Shudage-4 with direct effects in vitro,which are derived respectively from different single medicinal in Shudage-4.

Objective:To screen the differentially expressed immune-related genes(DEIRGs)in in-stent restenosis(ISR),and to analyze the immune cell infiltration in ISR,and to clarify the mechanism of occurrence and development of ISR.Methods:The mRNA gene expression data of GSE46560 dataset samples were downloaded from the Gene Expression Omnibus(GEO),and divided into ISR group and non-ISR group.The"Limma"package in R software was used to identify the differentially expressed genes(DEGs)which were then intersected with immune-related genes(IRGs)to identify the DEIRGs in ISR;R software was used for Gene Ontology(GO)functional enrichment andalysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway enrichment analysis on DEIRGs;the STRING database was used to construct the protein-protein interaction(PPI)network,which was visualized and analyzed for Hub genes by Cytoscape software;the receiver operating characteristic(ROC)curve of the Hub genes were plotted,and the area under the curve(AUC)was calculated and the diagnostic value was evaluated;CIBERSORT software was used to analyze the immune cell infiltration in ISR;Pearson correlation analysis was used to analyze the relationships between the immune cells and the relationships between the immune cells and key genes.Results:A total of 331 DEGs were identified(P<0.05,|log2FC|>1),including 176 upregulated genes and 155 downregulated genes,and 38 DEIRGs were obstained.The GO functional enrichment analysis results showed that the DEIRGs were mainly enriched in biological processes(BP)such as defense response,immune response,and immune system;in cellular components(CC),the DEIRGs were located primarily in the extracellular region and cytoplasmic membrane;and in molecular functions(MF),the DEIRGs were mainly involved in regulating signaling receptor binding and cytokine receptor activity.The KEGG signaling pathway enrichment analysis results indicated that the DEIRGs in ISR were primarily enriched in the phosphatidylinositol 3-kinase/protein kinase B(PI3K-AKT)and transforming growth factor-β(TGF-β)signaling pathways.In the PPI network,CD19 had the highest node among the top 10 Hub genes.Compared with non-ISR group,the expression level of the CD19 gene in the samples in ISR group was increased(P<0.05).The AUC value in the ROC curve of CD19 gene expression was 0.92(P<0.05).The immune cell infiltration analysis results showed that compared with non-ISR group,the infiltration level of T lymphocyte follicular helper(Tfh)cells in the patients in ISR group were increased(P<0.05),the infiltration levels of immature B lymphocytes,CD8+T lymphocytes,naive CD4+T lymphocytes,and M0 macrophages were increased,but the differences were not statistically significant(P>0.05),while the infiltration levels of memory B lymphocytes,activated memory CD4+T lymphocytes,regulatory T cells,resting natural killer(NK)cells,activated NK cells,monocytes,resting mast cells,and neutrophils were decreased,but the differences were not statistically significant(P>0.05).There were positive correlations between Tfh cells and M0 macrophages and resting mast cells(r=0.88,P<0.05;r=0.68,P<0.05),and there were negative correlations between Tfh cells and monocytes and neutrophils(r=-0.49,P<0.05;r=-0.42,P<0.05).Conclusion:CD19 may influence the occurrence and development of ISR by regulating the activation of the PI3K-AKT signaling pathway to affect the Tfh and B lymphocytes.CD19 can serve as a biomarker for the diagnosis of ISR.

Objective The immune response plays a crucial role in the progression of coronary heart disease(CHD).But the specific immune cells that may be causally related to CHD are still not fully understood.This study aimed to investigate the po-tential causal relationship between immune cells and CHD by using Mendelian randomization(MR)studies.Methods This study utilized publicly available Genome Wide Association Study(GW AS)data to analyze 731 immune traits in relation to CHD through MR analysis.The primary analytical method employed was the inverse variance weighting method to evaluate effects,with additional methods employed to corroborate the findings.Sensitivity analyses,including horizontal pleiotropy test,heteroge-neity test,and leave-one-out methods were also carried out.Results Following Bonferroni correction,a significant correlation was found between B cell absolute count(OR=1.064,95％CI:1.032-1.096,P＜0.01)and an increased risk of CHD.Sensitivity analysis was performed to confirm the reliability of these results.The inverse MR analysis suggested that there was no causal relationship between CHD and immune cells.Although other immune cell traits did not show a significant impact on CHD,they did exhibit low unadjusted P values.Conclusion This study highlighted the strong association between B cells and CHD at a genomic level,providing valuable insights for future clinical diagnosis and treatment.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Objective To forecast the number of healthcare professionals at China′s primary medical institutions from 2016 to 2020 ,so as to provide the healthcare authorities with references for optimizing healthcare human resource allocation .Methods The Grey model was used to predict numbers of healthcare professionals in China from 2016 to 2020 on the base of health technicians data from 2010 to 2015 .Results The forecast results show that the number of healthcare professionals may be increased to about 600000 people a yearfrom 2015 to 2020 .The number of healthcare professionals at China′s primary medical institutions is expected to grow about 204000 people a year ,and general practitioner is increased to about 22000 people a year .The annual growth rates of medical(assistant) practitioners ,medical practitioners ,registered nurses ,pharmaceutical personnel and examiners in China are expected to be 3.20％ ,2.81％ ,6.88％ ,1.53％ and 2.16％ respectively. The annual average growth rates of postgraduates ,undergraduates and junior college graduates are expected to be 16.95％ ,12.08％ and 5.46％ respectively .Conclusions in the future ,the requirements for healthcare professionals at primary institutions will still be higher than demand in China ,with a gap to be filled and their professional makeup and academic title make to be optimized. Therefore greater efforts are required for their development to enhance their competence and professionalism ,with reasonable staffing of the human resources .